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Who Are the Level IV Treatment Foster Care Kids and What Do They Need?

Who Are the Level IV Treatment Foster Care Kids and What Do They Need?. Jean Solomon , M.A., M.S.N. Mark R. Groner , M.S.S.A., L.I.S.W.-S. Attendees’ Goals for Today?. Established in 1852, now serving NE Ohio and beyond $25 million annual budget Staff of 450

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Who Are the Level IV Treatment Foster Care Kids and What Do They Need?

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  1. Who Are the Level IV Treatment Foster Care Kids and What Do They Need? Jean Solomon, M.A., M.S.N. Mark R. Groner, M.S.S.A., L.I.S.W.-S.

  2. Attendees’ Goals for Today?

  3. Established in 1852, now serving NE Ohio and beyond • $25 million annual budget • Staff of 450 • Prevention, early intervention and treatment programs ranging from sex education in schools to a secure Intensive Treatment Unit for SED children and teens

  4. Learning Organization Principles • Systems Thinking • Mental Models • Shared Vision • Team Learning • Personal Mastery

  5. Learningand Performance Improvement Cycle • Reflect • Define and Analyze Problem • Develop Shared Vision • Identify Outcome Criteria • Map Current Processes Connect *Look For Similarities *Identify/Gather Source Data *Do *Implement Solution/Design *Monitor and Evaluate Impact and Quality *Ask if Information Can Be Used Elsewhere • Decide • Identify Possible Solutions • Decide on Best Solution • Create New Process Maps/Design

  6. Outcome Measurement Using the Ohio Scales • Quarterly Monitored Performance Improvement Outcomes using Youth Ohio Scales Standardized Outcomes Measure Problem Severity: lower scores are desirable. Functioning: higher scores are desirable.

  7. Agency Foster Care • “Waystation” • Family Foster Care • Treatment Foster Care • The 90’s and Permanency • Growth of the community – based organizational arm • Transformation of Residential Treatment to stabilization and family identification/reunification • Shortened LOS’s • “Virtual RT” or Level IV Foster Care

  8. How do we help families accept increasingly challenging kids? How do we safely support the youth and families? What type of training do the parentss need? How do we change the culture and mental models to embrace the care of teens? How do we recruit? How do we manage risk? Level IV Foster Care

  9. “LIV” Program Description • Intensive staff ratio’s • Robust foster parent training/mentoring • Daily phone contact • Wrap around services • Access to full care continuum MH services • Semi-weekly team meetings • Flexible FA dollars • Liberal respite • Geographic FP support groups • FP steering group • A lot of celebrations

  10. REFLECT

  11. Define the Problem • Ohio Scales: Aggregate rate of clinically reliable improvement in the agency’s foster care program was below the agency’s and statewide benchmarks Symptoms Functioning

  12. Define the Problem (continued) • Placement Stability: the mean number of placements while in Beech Brook Treatment Foster Care per level of care • Level I = 1.6 • Level II = 1.8 • Level III = 2.4 • Level IV = 2.9

  13. Are there different trajectories among foster care youth by levels and within levels?

  14. How do we answer the Question? • Focus on LIV youth • Compare the youth who remain the same/stable or get better, to those who appear to get worse on the Ohio Scales. • How are these subgroups the same or different? • What does the sub group that is faring poorly need that may be different from what BB normally provides?

  15. CONNECT

  16. Sources of Data

  17. Disclaimer: There are no silver bullets……

  18. Research Team Discussions

  19. Quantitative Data: Race/Ethnicity and Gender

  20. Quantitative Data: Traumatic Experiences

  21. Quantitative Data: Education

  22. Quantitative Data: Placement Information

  23. Quantitative Data: Custody Type

  24. Quantitative Data: Outcomes Comparisons by Key Variables • On average, females make more progress than males in the program but they are also more symptomatic than their male counterparts • In general, special assistance around educational needs is associated with better outcomes • African American youth tend to make less functional progress • Level IV clients with 3 or more residential treatment admissions in their course of treatment struggle especially hard to make progress • In general, the presence of high levels of trauma is associated with poor outcomes

  25. Qualitative Case Study: The general pattern is that these complex clients have trajectories that reflect many ups an downs over time in their functioning and symptoms (as measured by the OS’s) 12/12/08-3/12/09 Level 2 (JH & MH Foster Home) 3/12/09-4/12/09 ITU 4/13/09-11/10/10 Level 4 (04/13/09-06/03/09, JH & MH Foster Home -06/03/09-11/10/10, VT Foster Home) 11/10/10-12/13/10 ITU 12/13/10-1/6/11 Level 4 (RG Foster Home) 1/6/11-1/27/11 ITU 1/27/11-5/6/11 Res 5/6/11-5/16/11 ITU 5/16/11 Res

  26. Literature Review Small study with baseline group differences. Compare TFC to treatment as usual. Focus on placement stability and behavior problems. Compare MTFC to Group Care. Focus on recidivism, delinquency.

  27. DECIDE

  28. Small Group Discussion Given these data, decide what you believe are the key components of a successful program redesign?

  29. Contact Information Jean Solomon jsolomon@beechbrook.org 216-831-2255, ext. 2300 Mark R. Groner mgroner@beechbrook.org 216-831-2255, ext. 2402 Beech Brook 3737 Lander Road Cleveland, OH 44124

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